The US Task Force on Preventive Services just released new draft breast cancer prevention guidelines, and they raise a few questions. The medical expert panel now recommends that women start having regular mammograms at age 40 – a huge departure from previous guidelines, which stated that women should start mammograms at age 50.
This is a draft recommendation – in other words, it’s not final yet – but it should become official in a few months.
According to the new draft guidelines, women should be screened for breast cancer every two years starting at age 40 to reduce their risk of dying from the disease. “While the task force has always recognized the lifesaving value of mammography, we have previously recommended that women in their 40s make an individual decision about when to begin screening based on their medical history and preferences,” says a statement from the working group. “In this new recommendation, the task force now recommends that all women get tested from the age of 40. This change could save 19% more lives.”
But the screening recommendations are different from those of other organizations, including the American College of Obstetricians and Gynecologists and the American Cancer Society, which are also different from each other. What’s going on here and why are breast cancer prevention guidelines so confusing? Doctors break it all down.
What led to the new mammography screening recommendations?
It is important to emphasize that the screening recommendations come back to what the working group recommended around mammograms. In 2009, the organization raised the recommended age for routine mammograms from 40 to 50. At the time, the committee expressed concerns that starting screening at age 40 could lead to unnecessary treatments, such as unnecessary biopsies and other therapies rather than false positives for cancer.
But since then, breast cancer diagnoses have increased, particularly among women under 50 and younger black women, who are dying of breast cancer at nearly double the rate of white women of the same age.
“New and more inclusive science about breast cancer in people under 50 has allowed us to expand on our previous recommendation and encourage all women to get screened in their 40s,” the group wrote. work on its website. “We’ve known for a long time that breast cancer screening saves lives, and science now supports all women who get screened, every two years, starting at age 40.”
Dr. Christine Edmonds, assistant professor of radiology at University of Pennsylvania Hospitals, told Yahoo Life: “There is overwhelming evidence that, for women at average lifetime risk of breast cancer, the starting screening at age 40 saves the most lives, compared to age 45 or 50. Additionally, most years of life are lost to breast cancer in women diagnosed in their 40s compared to women diagnosed in any other decade of life.
Edmonds says that when you factor this in knowing there is “minimal risk” in screening women in their 40s, “it’s with a resounding ‘yes’ that we recommend women start screening no later than later than 40 years old.
Dr. Melissa D. Fana, director of women’s health for Suffolk County at NYU Langone’s Perlmutter Cancer Center, told Yahoo Life that the new recommendations are a “very important step in protecting women,” adding: “We know mammography saves lives.”
But many doctors say they have recommended women get screened for breast cancer from age 40, regardless of what the task force has said in the past. “This has been our practice despite previous guidelines,” Dr. Parvin Peddi, medical oncologist and director of medical breast oncology for the Margie Petersen Breast Center at Providence Saint John’s Health Center, told Yahoo Life. “There are still many patients diagnosed before age 50.”
Edmonds and Dr. Therese Bevers, medical director of the Cancer Prevention Center at MD Anderson Cancer Center, also told Yahoo Life that their medical centers recommend annual screenings for women at average risk.
How often should people at medium or high risk be screened?
The task force guidelines say all women should start regular mammograms at age 40, but women considered high risk may need to start screening even earlier.
“Women at higher risk for breast cancer should also be screened annually,” Edmonds said. “The age at which to start screening depends on their specific risk factors and level of risk and should be determined by a breast cancer specialist. (Factors such as your family and personal history may weigh in on your risk of breast cancer.)
“There are some really good risk analyzes you can do online to figure out your risk,” Dr. Michele Blackwood, chief of the breast surgery section at the Rutgers Cancer Institute in New Jersey, told Yahoo Life. “If your lifetime risk is 20% or more, you are definitely at high risk.”
Why do some organizations have guidelines that differ from the recommendations of the new US Task Force on Preventive Services?
The American College of Obstetricians and Gynecologists recommends women have mammograms every one to two years, starting at age 40 — and the organization has maintained that recommendation for years. The American Society of Breast Surgeons also recommends annual screenings at age 40, and the American Cancer Society suggests having mammograms starting at age 45. Why is there a difference?
“We don’t know what drives them to do what they do,” Blackwood says. “THE [Task Force] the recommendation to wait until age 50 was confusing. Blackwood favors annual screenings, rather than the task force’s latest recommendation every two years. “If you do them every year, you will find cancers at earlier stages,” she says.
A big part of why organizations recommend annual or semi-annual (every two years) screenings comes down to risk assessment, Bevers says. “Organizations that say they have annual mammograms say, We know fewer women will die of breast cancer this way“, she says. “Organizations that say they get tested every two years want to minimize the possible harm of false positives.”
The task force noted online that the organization has analyzed modeling of the risks and benefits of screening every year or two and found that “when you weigh the lives saved against the harms like follow-up and unnecessary treatment, women benefit more when screening is done every other year.”
But experts say it really is best to have an annual mammogram. “The reasons given by the [Task Force] for biennial screening as opposed to annual screening — the potential for recalls, for example — is nebulous at best,” says Edmonds.
Why isn’t dense breast advice included and why is it important?
Women with dense breasts have an increased risk of developing breast cancer, which the task force acknowledges. However, the organization also says it does not yet have any specific recommendations for women with dense breasts.
“We still don’t have enough data to make clear screening recommendations in terms of who needs additional screening and how to provide this additional screening in women with dense breasts,” says Edmonds. “Much more research is needed to better understand who may need additional screening, when in their lives they warrant additional screening, and how to screen them.”
What does all this mean for insurance?
The task force’s recommendations generally guide drug testing insurance coverage, Bevers says. “Thus, a recommendation to begin screening mammography at age 40 protects insurance coverage for women age 40 and older,” Edmonds said.
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